Provider Demographics
NPI:1891795811
Name:HOPWOOD, MARY B (NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:HOPWOOD
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-471-0033
Mailing Address - Fax:617-770-4354
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-471-0033
Practice Address - Fax:617-770-4354
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165938363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0349968Medicaid
MANP2936Medicare ID - Type Unspecified
MAP20881Medicare UPIN